INITIAL DATABASE

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					Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City

COLLEGE OF NURSING

FAMILY NURSING CARE PLAN

In Partial Fulfillment of the Requirements of the Subject

H.C. 102
(Primary Health Care II – R.L.E.)

Presented by: Rufelia D. Taculog Lyra Jurado BSN II – B

Presented to: Ms. Aiza Ramos, R.N. (Clinical Instructor)

Date of Submission: February 23, 2009

INTRODUCTION

Family is basic social group united through bonds of kinship or marriage, present in all societies. Ideally, the family provides its members with protection, companionship, security, and socialization. The structure of the family and the needs that the family fulfills vary from society to society. The nuclear family – two adults and their children – is the main unit in some societies. In others, it is a subordinate part of an extended family, which also consists of grandparents and other relatives. A third family unit is the single-parent family, in which children live with an unmarried, divorced, or widowed mother or father.

Anthropologists and social scientists have developed several theories about how family structures and functions evolved. In prehistoric hunting and gathering societies, two or three nuclear families, usually linked through bonds of kinship, banded together for part of the year but dispersed into separate nuclear units in those seasons when food was scarce. The family was an economic unit; men hunted, while women gathered and prepared food and tended children. Infanticide and expulsion of the infirm who could not work were common. Some anthropologists contend that prehistoric people were monogamous, because monogamy prevails in nonindustrial, tribal forms of contemporary society.

Social scientists believe that the modern Western family developed largely from that of the ancient Hebrews, whose families were patriarchal in structure. The family resulting from the Greco-Roman culture was also patriarchal and bound by strict religious precepts. In later centuries, as the Greek and then the Roman civilizations declined, so did their well-ordered family life.

With the advent of Christianity, marriage and childbearing became central concerns in religious teaching. The purely religious nature of family ties was partly abandoned in favor of civil bonds after the Reformation, which began in the 1500s. Most Western nations now recognize the family relationship as primarily a civil matter.

Historical studies have shown that family structure has been less changed by urbanization and industrialization than was once supposed. The nuclear family was the most prevalent preindustrial unit and is still the basic unit of social organization. The modern family differs from earlier traditional forms, however, in its functions, composition, and life cycle and in the roles of husbands and wives.

The only function of the family that continues to survive all change is the provision of affection and emotional support by and to all its members, particularly infants and young

children. Specialized institutions now perform many of the other functions that were once performed by the agrarian family: economic production, education, religion, and recreation. Jobs are usually separate from the family group; family members often work in different occupations and in locations away from the home. Education is provided by the state or by private groups. Religious training and recreational activities are available outside the home, although both still have a place in family life. The family is still responsible for the socialization of children. Even in this capacity, however, the influence of peers and of the mass media has assumed a larger role.

Family composition in industrial societies has changed dramatically. The average number of children born to a woman in the United States, for example, fell from 7.0 in 1800 to 2.0 by the early 1990s. Consequently, the number of years separating the births of the youngest and oldest children has declined. This has occurred in conjunction with increased longevity. In earlier times, marriage normally dissolved through the death of a spouse before the youngest child left home. Today husbands and wives potentially have about as many years together after the children leave home as before. Some of these developments are related to ongoing changes in women’s roles. Women in all stages of family life have joined the labor force. Rising expectations of personal gratification through marriage and family, together with eased legal grounds for divorce and increasing employment opportunities for women, have contributed to a rise in the divorce rate in the United States and elsewhere. In 1986, for instance, there was approximately one divorce for every two marriages in the United States.

During the 20th century, extended family households declined in prevalence. This change is associated particularly with increased residential mobility and with diminished financial responsibility of children for aging parents, as pensions from jobs and government-sponsored benefits for retired people became more common.

By the 1970s, the prototypical nuclear family had yielded somewhat to modified structures including the one-parent family, the stepfamily, and the childless family. One-parent families in the past were usually the result of the death of a spouse. Now, however, most oneparent families are the result of divorce, although some are created when unmarried mothers bear children. In 1991 more than one out of four children lived with only one parent, usually the mother. Most one-parent families, however, eventually became two-parent families through remarriage.

A step-family is created by a new marriage of a single parent. It may consist of a parent and children and a childless spouse, a parent and children and a spouse whose children live

elsewhere, or two joined one-parent families. In a stepfamily, problems in relations between nonbiological parents and children may generate tension; the difficulties can be especially great in the marriage of single parents when the children of both parents live with them as siblings.

Childless families may be increasingly the result of deliberate choice and the availability of birth control. For many years the proportion of couples who were childless declined steadily as venereal and other diseases that cause infertility were conquered. In the 1970s, however, the changes in the status of women reversed this trend. Couples often elect to have no children or to postpone having them until their careers are well established.

Since the 1960s, several variations on the family unit have emerged. More unmarried couples are living together, before or instead of marrying. Some elderly couples, most often widowed, are finding it more economically practical to cohabit without marrying. Homosexual couples also live together as a family more openly today, sometimes sharing their households with the children of one partner or with adopted or foster children. Communal families, made up of groups of related or unrelated people, have long existed in isolated instances. Such units began to occur in the United States during the 1960s and 1970s as an alternative life-style, but by the 1980s the number of communal families was diminishing.

INITIAL DATABASE

A. Family Structure, Characteristics and Dynamics

The del Castillo family, extended in type, is composed of eight members, living on the eastern part of the road in Ayusan Sur. Mr. Edwin del Castillo, 43 years old, and his wife, Mrs. Cathaline del Castillo, 35 years old, have five children. The eldest among them is Mark, 13 years old, first year high school at the Ilocos Sur National High School (ISNHS). Next to him is Gladys Ann, 12 years old, and is presently studying at Vigan Central School as a Grade 6 pupil. Their third child is Joshua, 9 years old, Grade 3 pupil at Ayusan–Paoa Elementary School. Second to the last is Erica, 5 years of age, kindergarten and Reyn, 2 years old, as the youngest. Ms. Perlita del Castillo, 69 years old, aunt of Mr. Edwin del Castillo, lives with them. Decision – making in terms of the expenditure of money, daily living, education, involvement in the barangay activities and in matters of health care, lies to both the father and mother. They talk about such issues then decide as to what they think is the best for it. The breadwinner of the family is Mr. del Castillo who is a carpenter. Mr. and Mrs. del Castillo have a good marital relationship but often argue because of Mr. del Castillo’s frequent alcohol intake. “Nu awan trabaho, dapat awan arak…” as verbalized by Mrs. del Castillo.

B. Socio-Economic and Cultural Characteristics

All members of the del Castillo family are Born Again Christians. Mr. del Castillo is a high school graduate and works as a carpenter in Manila before. He went home last December 29, 2008 and is waiting for the start of another job this February. Mrs. del Castillo is a housewife; she cares for their children and accepts laundry when her sister offers her for extraincome. Ms. Perlita del Castillo also stays at home. She helps in the providence of the daily needs through her money in the bank which she has after they sold a piece of their land. All the children are schooling except Reyn who does not belong on the school-age yet. Both the father and mother contribute in decision-making. The monthly income of the family is P 8,750.00. They allot great amount for the basic needs of the family members such as food, education of the children and others. When Mr. del Castillo works consistently, that amount is enough to meet the basic needs of the family members. “Nu haan tuloy–tuloy wenno awan ti trabaho, gipit kami…” as uttered by Mr. del Castillo. They were active members of the R.I.C. before and Mrs. del Castillo even joined Gabriela and Balikatan but loose on those organizations because according to her, they haven’t received any benefits from those. She said that when there is a blessing, they don’t receive even just a sprinkle of it, so they just untied. They own chickens.

C. Home and Environment The house of the del Castillo family is medium-type – that is, a house made-up of mixed materials, bolo / wood on the kitchen and “pan-aw / labig” on the windows but with cement floor and wall. They have two bedrooms – one occupied by the father, mother and Reyn and the other one is not actually occupied by the other children when sleeping time because they rather prefer to lie on the “salas” while watching and fall asleep there (the four children and Ms. Perlita del Castillo). When there are leftover foods, they out it on the refrigerator in the family house of Mr. del Castillo or put a cover and just let it on the table or sometimes up in the basket. There are flies in the kitchen. They do not actually have their own electric connection. Mr. Edwin del Castillo, his brother and sister connect to the house of their mother for electricity and when the collection time comes, the amount is divided into four and their mother collects for the payment of each and one of them to pay the bill. They get their water from the pump which is located inferior to their house. Seven families depend on the said pump for water. The del Castillo family directly drink the water without boiling or chlorinating it. They store their water in a covered gallon. Their toilet, which is water-sealed in type, is located just some steps from the water pump and four families are using it. The drainage system is open and unlikely. In garbage collection, they don’t practice the segregation of biodegradable from the non-biodegradable ones. They just dump their garbage and burn when dry. They have a congested neighborhood – the houses are very near to one another (about 1–4 meters). They don’t have social (cell phones) and health facilities (apparatus and medicines) available. They don’t own a motorcycle but they have a bicycle. “Iwas disgrasya…” Mrs. del Castillo mentioned.

D. Health Status of Each Family Member

The del Castillo children has no history of hereditary diseases or condition. According to Mrs. del Castillo, most of the children of the sisters and brother of Mr. del Castillo inherited asthma from their ancestors but luckily, their five children don’t. Ms. Perlita del Castillo is hypertensive and she’s taking a maintenance drug. But if there’s no available drug, she uses garlic instead. Cough and colds are the common health problems of the family. Mrs. del Castillo had given birth five times and all of her pregnancies were normal.

E. Values and Practices on Health Promotion / Maintenance and Disease Prevention

All the children of Mr. and Mrs. del Castillo were all immunized. When the student nurses conducted the survey, they found out that Erica and Reyn (last two children) have a yellow card and a complete immunization status. They only see the doctor when there’s a problem regarding their health. Mr. and Mrs. del Castillo practice natural family planning method – rhythm and withdrawal. For the choice of food of the family, Mrs. del Castillo

verbalized that they give what is nutritious, “Ited diay nasustansya, diay nasayaat para kanyada. Haan da met agpilpili, nu pinnangan, mangan da lattan…” For the five times that Mrs. del Castillo have given birth to five children, she walks and walks before labor for the baby to come out faster. Mr. del Castillo smokes and consumes one pack of cigarette per day and also drinks alcohol (1 bottle) so often which sometimes causes an argument between him and his wife. Mr. del Castillo don’t mind even if having these vices will give him a health problem. Watching television is their form of relaxation and the children usually play baseball and “hide and seek”. Doing the household chores is an exercise too, according to Mrs. del Castillo.

FIRST LEVEL ASSESSMENT Health Strengths Health Problems Health Threats

1. Family resources adequate for family size. Cues:   Monthly income of P 8, 750.00. Children are sent to school.

1. Presence of accident hazards. Cues:   Fire hazards (multiple electrical connection) Congested neighborhood.

2. Proper role assumption. Cues:    Father is the breadwinner. Mother does the household chores and takes care of their children. Children go to school and help in the household chores.

2. Unhealthful habits. Cues: 

lifestyle

and

personal

Frequent alcohol intake of Mr. del Castillo, about one bottle a day with his brother.



Smoking habit of Mr. del Castillo (one pack a day).

3. Adequate personal belongings, utensils and food storage. Cues:     Presence and use of cabinets. Plastic storage. Kitchen utensils are enough for the entire family. Clothing is sufficient. wares and basket for

3. The family has a history of hereditary diseases. Cues:   Ms. Perlita del Castillo’s

hypertension. Asthma on the side of the father.

4. Incorrect smoking. Cues: 

idea

/

belief

regarding

4. Good ventilation. Cues:  Out of 4 rooms (two sleeping rooms, kitchen and living room), there are 8 windows available.

Mr. del Castillo don’t mind if smoking will cause him a health problem because of his uncle’s belief that white and red nicotine have different effects on the body (the red one is more hazardous).

5. Good marital relationship. Cues: 5. Improper garbage disposal.



There is a good collaboration between the father and the mother.

Cues:  The family does not segregate biodegradable from non-

biodegradable waste materials.

6. Improper food handling. Cues:  Unsafe water for drinking and cooking.

7. Poor environmental sanitation. Cues:    Comfort room is so near the source of water. Unlikely drainage. Presence of breeding or resting sites of insects, rodents and other vectors like bottles, open receptacle

garbage system and animal manure (chickens).  Presence of flies in the kitchen.

Foreseeable Crisis

1. Unstable job of the father. Cues:  Mr. del Castillo is last employed last December and will just have a job as a carpenter this coming February.

2. Entrance to school. Cues:  Gladys Ann is already Grade 6 and will already be having her

secondary education.

SECOND LEVEL ASSESSMENT Problems and Cues Health Threat Second Level Assessment

1. Presence of accident hazards. Cues:  

Inability to provide a home environment which is conducive to health maintenance and

Fire hazards (multiple electrical personal development due to inadequate family connection) Congested neighborhood. resources specifically financial constraints / limited financial resources.

2. Unhealthful habits. Cues: 

lifestyle

and

personal Inability to practice a healthy lifestyle due to prolonged smoking and drinking which are already considered as habits.

Frequent alcohol intake of Mr. del Castillo, about one bottle a day with his brother.



Smoking habit of Mr. del Castillo (one pack a day).

3. The family has a history of hereditary Inability to make decisions with respect to taking appropriate health action due to diseases. Cues:   Ms. Perlita del inadequate knowledge about their history of Castillo’s hereditary diseases.

hypertension. Asthma on the side of the father. regarding Inability to make decisions with respect to taking action in lessening or stopping consumption due to incorrect idea / belief Mr. del Castillo don’t mind if smoking will cause him a health problem because of his uncle’s belief that white and red nicotine have different effects on the body (the red one is more hazardous). Inability to make decisions with respect to taking appropriate health action due to failure regarding the effects of smoking.

4. Incorrect smoking. Cues: 

idea

/

belief

5. Improper garbage disposal. Cues:



The family does not segregate to comprehend the nature, magnitude and biodegradable from non- scope of the problem.

biodegradable waste materials. Inability to provide a home environment which is conducive to health maintenance and Unsafe water for drinking and personal development due to lack of / or cooking. inadequate knowledge of importance of hygiene and sanitation.

6. Improper food handling. Cues: 

7. Poor environmental sanitation. Cues:   

Inability to provide a home environment which is conducive to health maintenance and

Comfort room is so near the source personal development due to lack of / of water. Unlikely drainage. Presence of breeding or resting sites of insects, rodents and other vectors like bottles, open receptacle inadequate knowledge of preventive measures.

garbage system and animal manure (chickens).  Presence of flies in the kitchen.

Foreseeable Crisis Inability to provide enough budgets for the family needs due to the unstable job of Mr. del Mr. del Castillo is last employed Castillo. last December and will just have a job as a carpenter this coming February. Inability to recognize the problem due to positive outlook in life. Gladys Ann is already Grade 6 and will already be having her secondary education.

1. Unstable job of the father. Cues: 

2. Entrance to school. Cues: 

PRIORITIZATION

Problem 1: Presence of accident hazards: fire hazards CRITERIA Nature of the Problem SCORE GIVEN 2 JUSTIFICATION It is a health threat because there is a presumption that the family members will have an alteration to their health status when this multiple connection results in fire. The problem is not so modifiable because the family doesn’t have enough resources (financially) to provide for their own electrical connection, yet the health worker and other people can give some tips to them about the danger of multiple connections. The family members said that they don’t consider this as a problem because for so long that the four families are connected with electricity, fire never came along. There is actually no preventive potential of the problem since there is no damage on the family yet and they haven’t done something to resolve it (multiple connections) to prevent fire. The family does not recognize this as a problem and also haven’t implemented actions to resolve it. COMPUTATION 2/3x1 ACTUAL SCORE: .67

Modifiability of the Problem

0.5

0.5/2x2

.5

Preventive Potential of the Problem

0

0/3x1

0

Salience of the Problem:

0

0/2x1

0

TOTAL SCORE: 1.17

Problem 2: Unhealthful lifestyle and personal habits: frequent alcohol consumption and smoking habit CRITERIA Nature of the Problem SCORE GIVEN 2 JUSTIFICATION It is a health threat because there is a probability that Mr. del Castillo may acquire certain diseases due to his frequent alcohol intake and smoking habit. There is current knowledge about the problem but Mr. del Castillo don’t mind if alcohol and cigarettes could give him health problems. The health worker can give some teachings about the danger of having these vices and the community also has present knowledge about it. Long duration of the existence of the problem but there is no management of the problem that has been done yet. Mr. del Castillo and his wife often argue regarding this matter. Mrs. del Castillo verbalized that frequent alcohol intake and the smoking habit of her husband is a problem to them but Mr. del Castillo don’t mind any criticisms of his wife about it. COMPUTATION 2/3x1 ACTUAL SCORE: .67

Modifiability of the Problem

2

2/2x2

2

Preventive Potential of the Problem

2

2/3x1

.67

Salience of the Problem:

1

1/2x1

.5

TOTAL SCORE: 3.84

Problem 3: The family has a history of hereditary diseases: hypertension and asthma CRITERIA Nature of the Problem SCORE GIVEN 3 JUSTIFICATION It is a health deficit because Ms. Perlita del Castillo is hypertensive (there is a presence of disease). The problem is modifiable because the family has current knowledge and is responding to the problem through the maintenance drug. The health workers shared to Ms. Perlita del Castillo that garlic is not yet proven to be effective in treating hypertension and the community has actually no resources and present knowledge about it. The problem is severe and has already caused an awkward feeling to Ms. Perlita del Castillo since she is already hypertensive years ago. She is using a maintenance drug. The family has recognized the problem and has also implemented actions to treat it by using a maintenance drug. COMPUTATION 3/3x1 ACTUAL SCORE: 1

Modifiability of the Problem

1.5

1.5/2x2

1.5

Preventive Potential of the Problem

3

3/3x1

1

Salience of the Problem:

2

2/2x1

1

TOTAL SCORE: 4.5

Problem 4: Incorrect idea / belief regarding smoking CRITERIA Nature of the Problem SCORE GIVEN 2 JUSTIFICATION It is a health threat because it might cause Mr. del Castillo to keep on smoking and get sickness out of it. Since the belief regarding smoking is incorrect, even the health workers who advise them that cigarette smoking is dangerous to health, they still ignore this fact. The problem / belief has already existed for so long and since they haven’t traced any disease caused by it yet, Mr. del Castillo will keep on smoking and will not manage the problem for resolution. Mrs. del Castillo verbalized that this is a great problem but even though she tells her husband to keep from smoking, still nothing is done and nothing happens. COMPUTATION 2/3x1 ACTUAL SCORE: .67

Modifiability of the Problem

1

1/2x2

1

Preventive Potential of the Problem

1

1/3x1

.33

Salience of the Problem:

1

1/2x1

.5

TOTAL SCORE: 2.5

Problem 5: Improper garbage disposal CRITERIA Nature of the Problem SCORE GIVEN 2 JUSTIFICATION It is a health threat because there is a possibility that a disease may occur from this problem and can cause pollution and global warming. The problem is slightly modifiable since there is availability of current knowledge about it but there are no available resources of the family and community but health workers give some tips that there should be a proper segregation of waste products. This problem has not caused damage on the family yet and there is no management that is implemented about it. This problem existed already for so long but they just don’t do anything about it. Any member of the family has not verbalized that their practice of not segregating their garbage is a problem so they are not doing something about it. COMPUTATION 2/3x1 ACTUAL SCORE: .67

Modifiability of the Problem

1

1/2x2

1

Preventive Potential of the Problem

1

1/3x1

.33

Salience of the Problem:

0

0/2x1

0

TOTAL SCORE: 2

Problem 6: Improper food handling CRITERIA Nature of the Problem SCORE GIVEN 2 JUSTIFICATION It is a health threat because through this, there is a tendency that the family might acquire such diseases. The family does not actually have current knowledge regarding this problem and the family does not actually have any resources to treat this problem yet the community does. Health workers including the student nurses give some health teachings about this matter. The problem has not created any damage on the family although it occurred already years ago. They are not doing anything to respond to the problem. The family does not consider this as a problem and they haven’t done any management. It is not a felt problem. COMPUTATION 2/3x1 ACTUAL SCORE: .67

Modifiability of the Problem

1

1/2x2

1

Preventive Potential of the Problem

1

1/3x1

.33

Salience of the Problem:

0

0/2x1

0

TOTAL SCORE: 2

Problem 7: Poor environmental sanitation CRITERIA Nature of the Problem SCORE GIVEN 2 JUSTIFICATION It is a health threat because there is a possibility that a disease may occur form this problem. If they still do not improve the environment due to presence of breeding or resting sites of insects, rodents and other vectors and unsafe water that may lead to more diseases. The problem is not modifiable because the family doesn’t have enough resources to solve the problem. Health workers can give some tips to them about sanitation but the community doesn’t have enough resources, yet there is a present knowledge about proper sanitation. There is no damage created on the family for now but the problem has been for so long already and the family has done something to treat those flies (sticky paper) but not on the unsafe water source. They haven’t mentioned that this is a problem to them and they are not implementing management and intervention. COMPUTATION 2/3x1 ACTUAL SCORE: .67

Modifiability of the Problem

1

1/2x2

1

Preventive Potential of the Problem

1

1/3x1

.33

Salience of the Problem:

0

0/2x1

0

TOTAL SCORE: 2

Foreseeable Crisis 1: Unstable job of the father CRITERIA Nature of the Problem SCORE GIVEN 1 JUSTIFICATION It is a foreseeable crisis because the family may not have enough funds for the family if the father will not have a stable job. The family members are knowledgeable about this. The family experiences crisis financially weeks ago due to the unstable job of the father. They are doing something to resolve this. The family members verbalized this as a problem and the father is already looking for another job to respond to this problem. COMPUTATION 1/3x1 ACTUAL SCORE: .33

Modifiability of the Problem Preventive Potential of the Problem

0.5

.5/2x2

.5

2

2/3x1

.67

Salience of the Problem:

2

2/2x1

1

TOTAL SCORE: 2.5

Foreseeable Crisis 2: Entrance to school CRITERIA Nature of the Problem SCORE GIVEN 1 JUSTIFICATION It is a foreseeable crisis because the family may have a financial problem about this matter. They don’t consider this as a problem and they don’t have enough resources to treat this. The family doesn’t consider this as a problem. It is not a felt problem. COMPUTATION 1/3x1 ACTUAL SCORE: .33

Modifiability of the Problem

0

0/2x2

0

Preventive Potential of the Problem Salience of the Problem:

0

0/3x1

0

0

0/2x1

0

TOTAL SCORE: 0.33

LEARNING INSIGHTS  Rufelia D. Taculog:

The healthcare structure of a community has a direct effect on the health of the people living with it. Within the five Sundays and five Mondays that we’ve been to Ayusan Sur for our CHN duty, we’ve learned a lot of things regarding the issues in different aspects of the community and we’ve been closer to the people there especially to our family for the FNCP. I learned how to interact with other people well. Communication and the way of dealing with other people is definitely an important element that we, as student nurses must possess and develop. The family’s neighbors, friends, school, church and organizations are substantial ingredients in knowing the family’s social support system. Influence affects a family’s way of living.

I have also proven what Friedman and Associates (2003) had identified regarding the four rationales of family-centered nursing care. I just want to state them here in my learning insights since I know that they’re noble ideas to be considered. First, the family is composed of interdependent members who affect one another. Second, a strong relationship exists between the family and the health status of its members; therefore, the role of the family is essential in every level of nursing care. The third rationale is that the level of health of the family and, in turn, each member, can be significantly improved through health promotion activities. Finally, illness of one family member may suggest the possibility of the same problem in other members; through assessment and intervention, the nurse can assist in improving the health status of all family members. Among all that my mind has absorbed in our CHN duty, I can now say that “to accomplish something, effort, patience, determination and devotion to work must sprout to someone.” And also, I realized how important someone must care for his or her valuables. Though my Mom always tells me I’m clumsy, the point is, “Do I like what happened?” Being a nurse is a great responsibility and requires tender loving care for every move, yet sometimes, mistakes and misfortunes exist. I had a great time at Ayusan Sur…  Lyra Jurado:

Families have certain basic tasks for survival and continuity and specific tasks related to the sequential stages of development throughout the life of the family. In contrast to community health nursing which focuses on populations within a community, community-based nursing is

centered on individual and family healthcare needs. The nurses practicing community-based nursing provide interventions to manage acute or chronic health problems promote health and facilitate self care. The nursing care provided within a community must be culturally competent and family-centered.

Illness may result a health crisis in a family. Brief changes in family tasks may occur if an illness strikes a family member.

I have learned how to take BP well as we face different people with different concerns. Most importantly, I realized how important a family is in building up a community.

BIBLIOGRAPHY

“Nu awan trabaho, dapat awan arak…” as verbalized by Mrs. del Castillo. “Nu haan tuloy–tuloy wenno awan ti trabaho, gipit kami…” as uttered by Mr. del Castillo. “Iwas disgrasya…” Mrs. del Castillo mentioned. “Ited diay nasustansya, diay nasayaat para kanyada. Haan da met agpilpili, nu pinnangan, mangan da lattan…” as verbalized by Mrs. del Castillo. Doenges, Marilyn E., Moorhouse, Mary Frances & Murr, Alice C. Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales, 11th edition, 2008. Taylor, Carol, Lillis, Carol & LeMone Priscilla. Fundamentals of Nursing, 5th edition, 2007. Microsoft Student with Encarta Premium 2009 www.wikipedia.com


				
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